Lionel M. “Mac” Bargeron was born November 4, 1923 in Savannah, Georgia. He served as a Lieutenant in the 3rd Division of the Army of the United States of America in Europe during the Second World War. After honorable discharge from the army, he earned a degree as batchelor of science from the University of Alabama, before proceeding to complete his Doctorate in Medicine at the Medical College of Alabama, now known as University of Alabama School of Medicine. Following graduation, he completed a residency in pediatrics of two years in New York at Babies Hospital, Columbia University. He then served as a research fellow with the United States Public Health service, before returning to Birmingham to the medical faculty of the University, where he was appointed Assistant Professor in 1957. He served as director of Pediatric Cardiology from 1966 until he stepped down in1989. He continued as Professor in the Division of Pediatric Cardiology until retirement in 1992.
Upon his retirement, the Board of Directors of the University of Alabama in Birmingham, and the State of Alabama Legislature, by resolution in 1993, named the newly constructed Pediatric Cardiology Suite in his honour. In 1996, also by resolution of the State of Alabama Legislature, the L. M. Bargeron, Jr Chair in Pediatric Cardiology was created, and is today occupied by Edward V. Colvin.
Following retirement, he remained active as an outdoorsman on the coast of Alabama, and indulged his lifelong passion for French language and literature, in particular the works of Marcel Proust. He was active in the development of Proust scholarship in the undergraduate and graduate programs at the University of Alabama in Birmingham. He passed away following a mercifully brief period after having been diagnosed with metastatic malignant melanoma. He died at home, after all too short a life, on January 11, 2005.
Mac's accomplishments in Pediatric Cardiology are well known to the readership of this publication. At the University of Alabama in Birmingham, he worked with pioneers and giants in the field of congenital cardiac surgery, including Sterling Edwards, John Kirklin, Al Pacifico, and Jim Kirklin. His major contribution to the field was the development of the technique of axial cineangiography, which provided the anatomical precision to allow successful surgical palliation of complex congenital cardiac disease. The collaboration between Mac and John Kirklin, which occurred on a daily basis in the dark of the cine review room, led to the development of pioneering operations for complex cardiac defects that both relieved suffering and advanced the field. Mac's detailed studies, and his understanding of pathologic anatomy, inspired Kirklin's confidence, allowing him to push the limits of congenital cardiac surgery. Their relationship was one of mutual respect. The combinations of talent and vision at Birmingham during this time attracted world leaders to advance the study of diagnosis and treatment of congenital cardiac malformations. In particular, Mac valued his collaboration with the great congenital cardiac morphologists, including Robert Anderson, Maurice Lev, Saroja Bharati, and Richard Van Praagh. He was passionate and opinionated even among these great minds, but respected data, and could be persuaded to change his opinion.
His beautiful angiograms are masterpieces of gray-scale and black and white imaging as much as they are masterpieces of anatomic detail. He was to cineangiography what Ansel Adams was to black and white photography. Furthermore, his technique was consistent, and led to reproducible results. He was a master of cutting down on the saphenous vein as primary access to the vascular bed. These well-done cutdowns preserved the femoral veins for later access. He used large bore catheters to deliver injections of relatively large volume at low pressure, thus avoiding the ectopy that spoils many otherwise well-planned injections. The positions chosen for the cameras resulted in heretofore unmatched anatomic detail. The long axial, 4-chamber, and cranially angulated views in regular use nowadays are all outgrowths of his original work. Most of these angiograms were done with the cameras in straight antero-posterior and lateral positions, with the patient turned to provide the appropriate angulation. Many of these images still grace the pages of authoritative texts in Pediatric Cardiology and Cardiovascular Surgery, in particular the Textbook of Cardiac Surgery produced by John Kirklin and Brian Barratt-Boyes.
His early images were produced on cut film, which moved at relatively slow frame rates. He was instrumental in working with industry to produce biplane equipment, and increasing the rates to 60 frames per second, despite the fact that many in the industry did not think this was possible. He also helped persuade the manufacture of equipment that utilized film of 35 millimeters dimensions. Mac insisted on the involvement of cardiovascular anaesthesia in all catheterizations in children. This improved safety, and allowed the cardiologist to concentrate on the details of the study while the airway was managed by experts. This resulted in very few aborted or incomplete studies. The concept of involvement of the cardiovascular anaesthetist in the catheter laboratory has also become widespread, and remains applicable today. His relentless pursuit of efficiency and reproducibility extended to the outpatient clinic. In spite of his reputation as a consummate cineangiographer, he recognized the utility of echocardiography early on. He integrated on site the means of obtaining cross-sectional echocardiographic images along with the electrocardiogram and the chest radiograph, so that all of these could be performed at a single site without need for moving the patient. This resulted in reduced waiting times, and efficient gathering of diagnostic information for surgical planning. He was an early advocate for surgery planned solely from non-invasive testing.
His skills as a leader and Divisional Director are legendary, and he was able to build a highly professional team of associates and personnel. His maxim was “treat those under you like gold and give hell to those above you.” Sadly, it is the opposite behaviour that is often found in corporate and academic culture today. The advances in the knowledge of congenital cardiac disease, and the patients that benefited from these efforts, will provide his honourable and durable legacy.
Over and above his professional achievements, Mac was a gracious southern gentleman, who was close to, and proud of, his lovely family. He was married to Mary Paty Bargeron for 55 years. He is survived by Mary and his three children, Paty Bryant, also a physician, Mrs. James Franklin (Ruthie) Ozment, and LM “Lee” Bargeron, III, as well as by numerous grandchildren. He spent many glorious days at his second home on the Alabama coast with his extended family. Following retirement, he made a clean break from medicine, even allowing his medical licence to lapse. When one of us met him by chance at a seafood restaurant on the coast, with the greeting of “Hello, Dr Bargeron”, his reply was “Please call me Mac, I'm not a Doctor anymore”. He was well known outside of medical circles in Birmingham and served as President of the Birmingham Country Club. He was very outspoken, often at times to the chagrin of his family. Mary remembers his chance encounter with an old acquaintance, not seen in many years. This gentleman, who was also a senior citizen, was greeted by Mac with “I thought you were dead”.
His life was a blessing to his family, friends, patients, colleagues, and trainees. His art will live on forever.
